Provider Demographics
NPI:1225187081
Name:GHOSH, SWAPAN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:SWAPAN
Middle Name:S
Last Name:GHOSH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1302
Mailing Address - Country:US
Mailing Address - Phone:570-622-2666
Mailing Address - Fax:570-622-1733
Practice Address - Street 1:1620 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1302
Practice Address - Country:US
Practice Address - Phone:570-622-2666
Practice Address - Fax:570-622-1733
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029377L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics